Legislation


Tex. Ins. Code Ann. art. 1369.0542 through 1369.0544 – Texas

Status: Enacted
Link: http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1369.htm - 1369.0542

TRANSPARENCY RELATED TO CERTAIN HEALTH BENEFIT PLAN COVERAGE: requires health benefit plan issuers to display formulary information, via a direct and conspicuous electronic link, on the issuer’s Internet website. The formulary disclosures must include, for each drug the cost-sharing amount, including: (i) the dollar amount of a copayment; or (ii) for a drug subject to coinsurance, the cost-sharing range (e.g., “under $100 – $;” $100-250 – $,” etc.). The formulary disclosures must also identify prior authorizations, step therapies, other protocol requirements, tier the drug is in (if a tier-based system), whether drug is included in plan deductible or not and how so, preferred formulary drugs, and an explanation of coverage for each formulary drug.
o HEALTH CARE PROVIDER DIRECTORIES: requires certain health benefit plan issuers to create physician and health care provider directories on the Internet. The directory needs to include the name, street address, and telephone number of each physician and health care provider and whether they are accepting new patients or not. The health benefit plan issuer must update the directories at least once per month.


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